Tuesday, May 26, 2009 techzit asks

Q: Start Meds?

Hello,

I'm a 34 year old male who has minor joint pain and a "mildly" positive RF factor of 33 (0-14 normal). All other blood work...including CCP, CRP, and SED are negative. The blood work was performed in Feb of this year (3 months ago). I have no stiffness or swelling and occassional redness in my fingers.

I'm currenlty in this "no man's land" with no clear answer on whether or not to start medication. My current approach is to wait until the clinical picture becomes clearer or the CRP and SED become positive. Does this seem like a reasonable approach? At the same time, I continue to read that early aggressive treatment is important so am concerned if damage could already be occuring.

Thanks for any insight,

Cory

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Answers (3)

Brad, Health Guide

5/26/09 11:15pm

I would talk to your RA doc and not wait if at all possible. Early, aggresive treatment is the best answer. Research what you can online and make an informed decision with your doctor.

Good luck to you!

Brad

techzit

5/27/09 8:37am

Thanks for the input Brad....when asking my RA doc he said he "could go either way"...great advice heh? :) He also indicated if I had any doubts that I should wait because once the meds are started, he would never recommend stopping them.

I've been having joint symptoms for about 5 months and just had an MRI of my hand yesterday and should get the results today. Even though it may not show anything this early, maybe we will see something that can help with the decision.

Brad, Health Guide

5/27/09 1:57pm

I hear you, you really have to take the bull by the horns with your medical team. Research all you can online and speak to him about it. The earlier you start treatment the less chance of further damage. Hope it works out for you!

Brad

Tortoiselvr

5/27/09 3:34pm

Hi Cory,

I was diagnosed less than three months ago - at the time my pain was more of the "palindromic" rheumatism that would flare and then return to 100% normal. In a very short amount of time I went from "sometimes stuff hurts and is red" to pain 24/7 (not excruciating but unrelenting.. and don't get me started on the fatigue issue ) - but my point is this - I cannot imagine what type of state I would be in if I had waited until I was at "this" point before beginning meds. It takes a long enough time for the meds to work - I'm glad I didn't put it off.

All of that being said, my blood work showed positive RA Factor of 381 and positive anti CCP - so my Dr. was pretty certain she was dealing with RA from the beginning - and she believes in aggressive early treatment.

I would certainly weigh your options, and even chart how you are doing (seems pointless if you aren't in a lot of pain, but you will notice changes and patterns) - if you see that the frequency and pain is increasing, then you may want to start medication at that point. Researching and learning all you can about when joint damage occurs most rapidly, etc. certainly won't hurt either.

I wish you well in your journey - we're happy you found us.

Tort

techzit

5/27/09 3:49pm

Thanks Tort for the feedback and great insight. Question: How long did you have the "palindromic" pain before the more clinical symptoms kicked in? Have you had an MRI done and have you seen any damage occuring since your diagnosis?

Not sure it means much as I hear it takes time for damage to show up, but my MRI today returned normal (this is after about 5 months of joint symptoms).

Tortoiselvr

5/27/09 4:04pm

I had palindromic for at least 4 years (here is info on it, it's not commonly discussed - http://www.palindromic.org/forum/), never went to the Dr for it because it would happen for about 24 hours, a few times a year, random joints. I figured it was something wrong in my diet - in the fall of 08 I noticed it was happening for longer periods of time and more frequently, and between Dec and Feb I had about 6 or 7 incidents, and they were overlapping - that is when I finally went to my PCP. He ran general tests (RA factor, sed rate, etc) and when those came back as they did, I was seen by the Rheumatologist. She put me on prednisone right away and two weeks later after her round of labs came back, she confirmed RA diagnosis (by this time I had "become symmetrical" in my symptoms and was battling pain and fatigue daily) - and put me on meds. I've been on meds for 8 weeks - we're still working on figuring out how to treat me (I'm on Methrotrexate, Prednisone and Folic Acid) - she did do hand xrays (no damage) two months ago - but yesterday when I saw her she said it would be too soon to see again on xrays but did bring up a possible MRI for discussion at my next visit (if my symptoms don't calm down before then).

I do know that for some people damage is an immediate onslaught - for others slower, but I do believe (based on what I've read) that a lot of "beginning damage" occurs in the first couple of years. The pain, swelling, and redness we can all deal with, but once the damage occurs, you can't "undo" it. It's really good you were able to get the MRI done and know there is no damage yet - that is good news.

Perhaps your doctor would put you on a small dosage of one of the first round DMARDS - although I'm not sure what the "rules" are about "how much is need to be effective"

- Tort

Lene Andersen, Health Guide

5/27/09 8:06pm

The unfortunate reality of living with RA is that sometimes, the clinical picture remains muddy for quite some time. Don't wait until your blood work tests positive for RA - approximately 20% of people living with this disease are what is called seronegative, which means their blood work is negative for RA. We recently published a post about blood work, what it means and why it is merely one aspect of the diagnostic picture and you can read that here. Like one of the other people answering said, it is important to treat early and aggressively to maximize your chances of protecting your joints from permanent damage and helping you need a relatively normal life. Which is absolutely possible. You may want to check out our area about the basics of RA, as well as a section for the newly diagnosed, which contains tips on how to manage the disease and live well with it.

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